Randomized trials evaluate optimal atropine dosing for myopia control

A meta-analysis of randomized clinical trials found that atropine slowed myopia progression in children across a range of concentrations, though benefits appeared to level off at higher doses while side effects became more common.

Researchers reviewed 33 randomized clinical trials involving 6,301 children aged 4 to 18 years that compared atropine eye drops with placebo. The studies evaluated 10 atropine concentrations and had a mean follow-up period of nearly 20 months.

The analysis showed a nonlinear relationship between atropine concentration and treatment effect. Compared with placebo, atropine slowed myopia progression more as concentrations increased, with benefits rising from 0.21 diopters at 0.01% atropine to 0.46 diopters at 0.05%. Higher doses showed even greater effects, though those results came from fewer and smaller studies.

Researchers also found that higher atropine doses were associated with more side effects, including reduced accommodation, larger pupil diameter, and a higher frequency of photophobia.

The authors noted that treatment benefits may plateau beyond a certain concentration range and cautioned that estimates for concentrations above 0.1% should be interpreted carefully because of limited trial data, study heterogeneity, and incomplete refractive history reporting in many studies.

Reference
Zhang XJ, Liu M, Yu M, et al. Efficacy, tolerability, and threshold effect of atropine eye drops for myopia control: A systematic review and dose-response meta-analysis. Surv Ophthalmol. 2026;S0039-6257(26)00052-4. doi: 10.1016/j.survophthal.2026.04.002. Epub ahead of print. PMID: 42070753.